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We thank Dr. Weiskopf for his letter concerning our Editorial View.1 We agree with him that conflict of interest is a complex issue. Nevertheless, Dr. Weiskopf has chosen to ignore our most important concern. Guidelines and practice parameters should not be promulgated by groups without standing
. The primary reason we criticize guidelines and practice parameters offered by “shadow” organizations is that there is no large national or international medical organization that vets their work. For whom and for what purpose are these guidelines and practice parameters being created when they do not arise from a relevant national or specialty society? Why should physicians be encumbered by guidelines or practice parameters the contents of which have not been vetted by physicians in open fora at national or international medical meetings? Why should physicians be encumbered by guidelines or practice parameters that were initiated and funded by a company, not by a relevant national or international medical association?

We have served on task forces that have created guidelines and practice parameters. It is a difficult job, and it must be done correctly, without undue influence from sponsors with vested interests. There can be problems even when relevant organizations sponsor guidelines if they provide conflicting recommendations.2 Groups without standing should find another line of work.